Effects of Workshop Training on Practice Element Utilization among Therapists in a Youth Public Mental Health System.

Abstract

Despite significant advancements for properly defining and establishing evidence-based practices (EBPs) for specific disorders and populations, there continues to be a science-practice gap in community mental health settings. One strategy that has been examined to increase the rate of EBP utilization is adapting evidence-based training processes (and related factors influential to those processes) to better fit large community mental health systems. Of particular interest, recent research has suggested that a modular approach to treatment and training may be a useful method for striking a balance between the prescriptive nature of EBPs and the need for flexible implementation within community mental health. Thus, the present investigation had two overarching foci within the context of a large scale modular therapy training initiative on various practice elements: to examine the extent to which community therapists appropriately applied treatment techniques focused on at these trainings, and the extent to which community therapists failed to appropriately apply treatment techniques focused on at trainings. Longitudinal, archival data from community mental health providers (n = 47) who participated in a series of state-sponsored anxiety and/or disruptive behavior workshops in modular approaches to EBPs for youth in Hawaii was examined. Utilizing two different methods of three-level mixed model approaches (i.e., cross-classified multilevel modeling and generalized linear mixed modeling [level-1: effects of time, level-2: client factors, and level-3: therapist factors]), average rates of change in therapists’ EBP utilization were examined following their attendance at the specific types of workshops (e.g., therapists’ use of trained anxiety techniques was examined following attendance at an anxiety workshop). Client and therapist characteristics, within which these treatment episodes are embedded, were also investigated within these analyses for their potential effects on utilization patterns. Results indicated that time, client age, training attendance, and therapist specific technique knowledge were significant predictors of therapists’ technique utilization rates. However, therapists’ attitudes towards evidence-based practices was not a significant predictor. Youth community therapists within this sample selfreported increases for their appropriate utilization of the anxiety trained techniques following the anxiety training, yet decreased in their self-reported appropriate use of disruptive behavior techniques after the disruptive behavior training. These results potentially suggest that the effects of training on specific technique implementation are moderated by a variety of factors, including not only traditionally studied therapist and youth factors, but also the type of problem area addressed at the training. Study limitation and implications for EBP dissemination and implementation are further discussed.